U.S. patent application number 10/681906 was filed with the patent office on 2004-07-22 for systems for ultrasonic imaging of a jaw, methods of use thereof and coupling cushions suited for use in the mouth.
Invention is credited to Anisimov, Victor, Cohen, Dan, Efimov, Sergei, Eitan, Alon, Haas, Nadav, Jacoby, Yuval, Ocherashvili, Aharon, Passi, Garri, Pershitz, Boris, Shay-El, Yuval, Smirnov, Pavel, Stein, Uri.
Application Number | 20040143186 10/681906 |
Document ID | / |
Family ID | 34435379 |
Filed Date | 2004-07-22 |
United States Patent
Application |
20040143186 |
Kind Code |
A1 |
Anisimov, Victor ; et
al. |
July 22, 2004 |
Systems for ultrasonic imaging of a jaw, methods of use thereof and
coupling cushions suited for use in the mouth
Abstract
Systems and methods for ultrasonic imaging of a jaw and coupling
cushions suited for use in the mouth. The system includes a
specially configured ultrasonic probe, a position locator module
for defining a probe location and transmitting the definition to a
central processing unit (CPU) and the CPU. The CPU is capable of
receiving digital data from transducers in the probe and receiving
the location of the probe and producing an image of at least a
portion of a jaw. The method includes providing the ultrasonic
probe, defining its location and communicating the location to a
CPU and transmitting an signal from a transducer and receiving at
least a portion of the signal at at least one of the transducers.
The CPU receives transducer data and a location of the probe and
produces an image of the at least a portion of the jaw. An
ultrasonic coupling cushion is further disclosed.
Inventors: |
Anisimov, Victor;
(Petersburg, RU) ; Cohen, Dan; (Modiin, IL)
; Efimov, Sergei; (Haifa, IL) ; Eitan, Alon;
(Tel Aviv, IL) ; Haas, Nadav; (Merkaz Shapira,
IL) ; Jacoby, Yuval; (Tel Aviv, IL) ;
Ocherashvili, Aharon; (Bat Yam, IL) ; Passi,
Garri; (Ashdod, IL) ; Pershitz, Boris; (Moshav
Tzufit, IL) ; Shay-El, Yuval; (Ramat Gan, IL)
; Smirnov, Pavel; (Rishon Letzion, IL) ; Stein,
Uri; (Rosh Haayin, IL) |
Correspondence
Address: |
DR. MARK FRIEDMAN LTD.
C/o Bill Polkinghorn
Discovery Dispatch
9003 Florin Way
Upper Marlboro
MD
20772
US
|
Family ID: |
34435379 |
Appl. No.: |
10/681906 |
Filed: |
October 10, 2003 |
Current U.S.
Class: |
600/437 |
Current CPC
Class: |
A61B 8/0875
20130101 |
Class at
Publication: |
600/437 |
International
Class: |
A61B 008/00 |
Foreign Application Data
Date |
Code |
Application Number |
Apr 18, 2002 |
WO |
PCT/IL02/00311 |
Claims
What is claimed:
1. An improved ultrasonic imaging system constructed to facilitate
imaging of at least a portion of a jaw, the system comprising: (a)
a probe, said probe comprising at least one array of ultrasonic
transducers; (b) a position locator module designed and constructed
to be capable of defining a location of said probe in six degrees
of freedom and transmitting said definition to a central processing
unit; and (c) said central processing unit capable of; (i)
receiving from said probe digital data from each of said ultrasonic
transducers in said arrays; (ii) further receiving from said
position locator a location of said probe; and (iii) transforming
said digital data into an image of said at least a portion of a
jaw.
2. The system of claim 1, wherein said image is a three dimensional
image.
3. The system of claim 1, wherein said probe is a mandibular probe
designed and constructed to facilitate imaging of at least a
portion of a lower jaw and includes: (i) a first array of
ultrasonic transducers mounted upon a first wand, said first array
of ultrasonic transducers positionable distal to the lower jaw and
outside of a mouth; (ii) a second array of ultrasonic transducers.,
said second array of transducers mounted upon a second wand, said
second array of ultrasonic transducers positionable proximal to the
lower jaw and inside of said mouth: and (iii) at least one
connective member, said connective member designed and constructed
to connect said first and second wands one to another and to allow
relative positioning thereof; wherein said connective member
includes an assembly designed and constructed to attach said first
and second wands and facilitate translational motion of said wands
with respect to one another.
4. The system of claim 1, wherein said probe is designed and
constructed to facilitate imaging of at least a portion of an upper
jaw and includes a single curved array of ultrasonic transducers
mounted upon a wand, said wand designed and constructed to be
insertable into a mouth of a patient. The system of claim 1 wherein
said position locator module includes at least one first position
sensor located on said probe and at least one second position
sensor located on a head of a subject. The system of claim 1
wherein said position locator module includes a first mechanical
positioning mechanism designed and constructed to position said
probe and a retention means designed and constructed to engage and
retain a head (of a subject in a known position. The system of
claim 1, further including an ultrasonic coupling cushion, said
cushion comprising an elastic container capable of retaining a
coupling medium wherein said elastic container is designed and
constructed to be insertable in a mouth of a subject
8. A method of producing an ultrasonic image of at least a portion
of a jaw, the method comprising: (a) providing a probe, said probe
comprising at least one array of ultrasonic transducers (b)
defining a location of said probe in six degrees of freedom by
means of a position locator: (c) communicating said location to a
central processing unit; (d) transmitting an ultrasonic signal from
at least one of said transducers and receiving at least a portion
of said ultrasonic signal at least one of said transducers; and (e)
employing a central processing unit to; (i) receive a set of
digital data pertaining to said transmitting and receiving
performed by said transducers in said arrays of said probe; (ii)
further receive from said position locator a location of said
probe; and (iii) transform said digital data into an image of said
at least a portion of the jaw.
9. The method of claim 8, wherein said image is a three dimensional
image. The method of claim S, wherein providing a probe includes
providing a mandibular probe designed and constructed to facilitate
imaging of at least a portion of a lower jaw and includes: (i)
providing a first array of ultrasonic transducers mounted upon a
first wand, said first array of ultrasonic transducers positionable
distal to the lower jaw and outside of a mouth; (ii) providing a
second array of ultrasonic transducers, said second array of
transducers mounted upon a second wand, said second array of
ultrasonic transducers positionable proximal to the lower jaw and
inside of said mouth; (iii) providing at least one connective
member, said connective member designed and constructed to connect
said first and second arrays one to another and to allow relative
positioning thereof: and wherein said connective member includes an
assembly designed and constructed to attach said first and second
wands and facilitate translational motion of said wands with
respect to one another.
11. The method of claim 8, wherein providing a probe includes
providing a maxillary probe designed and constructed to facilitate
imaging of at least a portion of an upper jaw and includes a single
curved array of ultrasonic transducers mounted upon a wand, said
wand designed and constructed to be insertable into a mouth of a
patient.
12. An ultrasonic coupling cushion, the cushion comprising an
elastic container capable of retaining a coupling medium wherein
said elastic container is designed and constructed to be insertable
in a mouth of a subject.
13. The coupling cushion of claim 12, further comprising said
coupling medium.
14. The coupling cushion of claim 13, wherein said coupling medium
is selected from the group consisting of water, an aqueous
solution, a gel and a polymer solution.
15. The coupling cushion of claim 12, wherein said elastic
container further includes attachment device designed and
constructed to engage and retain at least a portion of an
ultrasonic probe.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority from PCT application
IL02/00311 filed on Apr. 18, 2002 and from U.S. Provisional
Application No. 60/284,918 filed Apr. 20, 2001.
FIELD AND BACKGROUND OF INVENTION
[0002] The present invention relates systems for ultrasonic imaging
of a jaw, methods of use thereof and coupling cushions suited for
use in the mouth. Specifically the invention relates to systems
which employ improved proe configurations which permit imaging of
the mandible and maxilla and facilitate visualization of bone and
nerve canals.
[0003] Diagnostic imaging of hard tissue has numerous practical
uses in various medical fields. In the fields of Dentistry, Dental
Surgery and Implantology, for example, X-ray and CT imaging are
extensively used for imaging the human upper and lower jaws.
However, such imaging techniques suffer from several significant
disadvantages. In order to illustrate the deficiencies of current
day techniques for imaging hard tissue, let us consider, for
example, existing jaw imaging techniques used today in dental
implant surgery.
[0004] In many mammals, including humans, the jaws (upper and
lower) comprise several layers of tissue. FIG. 1 shows a high-level
schematic sectional view of a human lower jaw, or mandible 30. The
external layer of mandible 30 comprises the gum 32, or the
mucoperiosteal tissue covering the jawbone. Beneath gum 32 is a
layer of cortical (compact) bone 34, which is normally dense bone
tissue. Beneath cortical bone 34 lies an area of trabecular bone
36, which is normally bone tissue softer than cortical bone. Within
the area of trabecular bone and along the mandibular jaw, runs the
mandibular canal 38 carrying the inferior alveolar nerve 39.
Mandibular canal 38 is an elongated tubular cavity of varying
density, usually comprising dense (cortical type bone) borders. In
cases where dense borders are not present, mandibular canal 38 is a
conduit within a sponge-like matrix. In the latter case, mandibular
canal cavity 38 may be distinguished from the cavities of the
trabecular environment 36 by the mandibular canal's regular shape,
i.e. an elongated tubular cavity. All cavities inside the
cross-section of mandible 30 are normally filled with fluids. The
upper region of the mandible forms the alveolar ridge 40 in which
teeth 42 are normally situated.
[0005] FIG. 2a shows a low-level schematic sectional view of
mandible 30. As mentioned hereinabove, in a normal situation
alveolar ridge 40 comprises sockets housing teeth 42. FIG. 2b shows
a sectional view of mandible 30 after the loss of a tooth, for
example, due to tooth extraction. It is well known that following
the loss of a tooth, the residual socket in alveolar ridge 40
regenerates and fills with hard tissue. The procedure of replacing
a tooth with an implant-supported prosthesis has become very common
and widely used. The process of fixture (implant) placement entails
exposing the bone (raising the mucoperiosteal flap), and drilling a
receptive site for the fixture. FIG. 2c shows a sectional view of
mandible 30 with a drill 70 drilling into the alveolar ridge 40.
The common procedure prior to installation of a dental fixture
involves, inter alia, drilling into the cortical 34 and trabecular
36 bone of mandible 30 using a drill 70, in order to prepare a
socket in which a fixture will be anchored. If an implantologist
drilling into mandible 30 is not aware of the topology and internal
structure thereof (e.g. precise location of mandibular canal 38)
then during the drilling procedure drill 70 may contact and damage
mandibular canal 38 and inferior alveolar nerve 39 situated
therein, or drill outside the bone boundaries. Such damage can
ultimately lead to severe pain, hemorrhage and even local
paralysis, among other undesired consequences. For this reason, it
is widely acknowledged that an implantologist must obtain an
internal image of the mandible prior to performing the implant
surgery.
[0006] Similarly, when planning implant surgery on a human upper
jaw, or maxilla, an implantologist will also need to obtain an
internal image of the jaw. FIG. 3a shows a schematic sectional view
of a maxilla 50. The maxilla comprises an external layer of gum 52,
under which lies a layer of cortical bone 54, enclosing an area of
trabecular bone 56. Under trabecular bone 56 lies another layer of
cortical bone 58 which serves as the floor of the sinal
and.backslash.or nasal cavities 60. In a normal (healthy) maxilla,
a tooth 62 is anchored in the cortical 54 and trabecular-56 bone.
FIG. 3b shows a sectional view of maxilla 50 after the loss of
tooth 62, for example, due to tooth extraction. When preparing a
receptive site for a fixture in maxilla 50, the implantologist uses
a drill 72 in order to drill a hole through the cortical 54 and
trabecular 56 bone. However, if the implantologist is not aware of
the internal structure and shape of the jawbone (e.g. the location
of sinal and/or nasal cavities 60), the implantologist may
perforate and damage cortical floor 58. Such perforation may lead
to a serious sinal infection and hemorrhage, as well as other
undesired consequences. It is therefore common practice to obtain
an internal image of the maxilla prior to the implant surgery.
[0007] The most common technique currently used in Implantology for
imaging the lower and.backslash.or upper jaw is Panoramic X-ray
Radiography. FIG. 4 is an example of a panoramic x-ray image of
human upper and lower jaws. In the lower jaw, mandibular canal 38
(black) appears inside trabecular bone area 36 (gray). A cortical
bone layer 34 (white) encloses trabecular bone area 36. In the
upper jaw, sinal and nasal cavities 60 (black) appear above
cortical floor 58 (white), which is above trabecular bone area 56
(gray), under which lies cortical bone layer 54 (white).
[0008] The panoramic X-ray technique suffers from some significant
shortcomings. First, it is well established that X-ray radiation is
hazardous to the health of the patient. Second, panoramic X-ray
produces a two-dimensional image of the jaw, which is perpendicular
to a cross-section of the jaw. This limitation makes the panoramic
image unreliable for guiding the implantologist to drill within the
bone boundaries and within a safe distance from the mandibular
canal, or the sinal.backslash.nasal cavities. The panoramic image
is inherently distorted and inaccurate because it projects the
three-dimensional jaw into a two-dimensional image. This image is
therefore unreliable also for assessing the depth of the bone
tissue available for drilling and preparing a fixture. Third, the
image is not taken chair-side and consequently, panoramic X-ray
does not allow for real-time monitoring of implant procedures. All
of the above disadvantages make the panoramic X-ray image a
hazardous, imprecise, and unreliable imaging solution.
[0009] Another imaging technique used in Implantology, though less
common, is Computerized Tomography (CT). FIG. 5a is an example of a
sectional CT image of a toothless mandible 30. Cortical layer 34
(white) encloses trabecular area 36 (gray), which surrounds
mandibular canal 38 (black ellipse). FIG. 5b is an example of a
toothless maxilla 50. Cortical layer 54 (white) covers trabecular
area 56 (gray). Cortical floor 58 (white) borders sinal and nasal
cavities 60 (black).
[0010] A CT image of an upper or lower jaw provides a sectional
view of the jaw, and is less distorted than panoramic radiography.
However, CT involves a substantially higher dosage of X-ray
radiation than conventional radiography, and therefore poses a
significantly greater risk to the health of the patient.
Furthermore, CT equipment is very expensive and is only rarely
found inside the clinic of the implantologist. CT can definitely
not provide a chair-side imaging solution.
[0011] The popularity of ultrasonic medical diagnostic systems has
significantly risen in recent years. In contrast to X-ray and CT
systems, ultrasonic systems have the advantage of not exposing the
patient or doctor to hazardous ionizing radiation, and are
generally more compact and economical. In the field of Dentistry
and Dental Implantology various ultrasonic diagnostic and
measurement systems are known.
[0012] International patent application PCT/IL00/00341 publication
no. WO 01/00102 entitled "Alveolar Bone Measurement System"
(hereunder "ABMS"), which is fully incorporated herein by
reference, discloses an ultrasound system for assessment of
distance between an area of interest and a known location of a
non-bone canal for use in drilling an implant receiving cavity in
the alveolar bone of a human subject's posterior mandible or
posterior maxilla. ABMS comprises an ultrasound probe capable of
being introduced at the area of interest and transceiving pulse
echo ultrasound signal to the alveolar bone and therefrom and an
electronic circuitry for processing the ultrasound signal and
providing an indication of the remaining alveolar bone distance
between the ultrasound probe and a canal within the alveolar
bone.
[0013] However, ABMS still comes short of answering the needs of
the dental implantologist for the following reasons. First,
measurement of time-of-flight (TOF) from a location on the surface
of the alveolar bone to a non-bone canal inside the jaw is, in
reality, impracticable or at least very imprecise due to the high
level of attenuation and scattering inside the jawbone. Although
the application further discloses an improved method in which a
second TOF measurement is taken after drilling a bore of known
depth, the improvement is still subject to the aforementioned
attenuation and scattering problem, and moreover, as mentioned in
the ABMS patent application itself (page 2 line 1) it is of
significance that the condition of the jaw be assessed prior to
drilling. Second, ABMS relies on the so-called "average velocity of
ultrasound within bone tissue, as known, per se" (page 4, line 14).
However, it is known that the velocity of ultrasound may vary from
patient to patient, and from bone to bone within a certain patient,
and even in different regions of a certain bone. Thus, even in the
case that ABMS manages to take a precise TOF measurement, it will
still not be able to calculate the precise distance from the probe
to the canal due to an error in the velocity of ultrasound. Third,
ABMS does not disclose any mechanism or procedure for ensuring that
the echo which is supposedly from the canal and on which the
distance measurement is based, is really from the canal and not
from another reflector inside the jawbone. Fourth, ABMS is limited
to measuring the distance from the canal to the alveolar bone, and
does not teach how to measure the distance between the canal and
the buccal and lingual walls of the jawbone, which is of
significant importance to the implantologist, e.g. in order to
determine an optimal angle of drilling. Lastly, being a measurement
system rather than an imaging system, the most ABMS can provide is
a numerical distance measurement from the location where the probe
is located to a canal within the bone, but no implantologist will
suffice with a mere numerical value as a basis for planning or
performing a drill into a jaw.
[0014] German Patent No. DE 19921279 (hereunder "the '279 patent"),
which is fully incorporated herein by reference, discloses a
surgical instrument for drilling into a bone, the instrument
comprising an ultrasonic transducer for transmitting and receiving
ultrasonic waves. The transducer is connected to a device which
generates signals according to the intensity and TOF of ultrasonic
energy received by the transducer, and these signals provide
measurements for determining the characteristics of the bone in the
direction of transmission. The '279 patent suffers from limitations
similar to those of ABMS, namely, impracticable or imprecise
measurement and insufficient information to the implantologist.
[0015] U.S. Pat. No. 6,030,221 entitled "Ultrasonic Apparatus and
for Precisely Locating Cavitations within Jawbones and the Like"
(hereunder "the '221 patent"), which is fully incorporated herein
by reference, discloses an apparatus which generates an ultrasonic
pulse and passes the pulse through the jawbone of a human. The
pulse is detected by an ultrasonic receiving unit. Attenuations in
the amplitude of the pulse are detected and displayed on a color
monitor. The color monitor allows the detection of cavitations by
interpreting color codes in a 4.times.4 matrix displayed oil the
monitor.
[0016] U.S. Pat. No. 6,086,538 entitled "Methods and Apparatus for
Evaluation of Bone Condition" (hereunder "the '538 patent")
discloses a method of evaluating the status of bone tissue, useful
in the diagnosis of osteoporosis, in which a calcaneus is scanned
in through-transmission mode, and a characteristic of ultrasound,
such as the speed-of-sound or attenuation, is measured in different
locations. The location of a circular (as seen from the side) area
of reduced attenuation inside the calcaneus is derived from the
ultrasound measurements, and finally the status of the examined
bone tissue is evaluated based on the measurements which were taken
in that circular area.
[0017] Both the '221 patent and the '538 patent concentrate on the
problem of assessing the quality or health of the bone under
examination rather than providing an image of the bone for guidance
in a medical procedure. As a result, both these patents provide
only a two-dimensional attenuation map of the examined bone which
is perpendicular to a cross-section of the bone, and furthermore,
include no mechanism or procedure for precisely calculating the
distance of the detected cavitations (in the case of the '221
patent) or the circular area of reduced attenuation (in the case of
the '538 patent) in relation to a reference point of interest. As
mentioned hereinabove in connection to the panoramic X-ray
technique, a lateral two-dimensional image is unreliable for
guiding the implantologist to drill within the bone boundaries and
within a safe distance from the mandibular canal, or the
sinal/nasal cavities.
[0018] German Patent No. DE 4205360 (hereunder "the '360 patent"),
which is fully incorporated herein by reference, discloses an
ultrasonic measuring gauge for determining jawbone width. U.S. Pat.
No. 5,427,105 entitled "Measuring Procedure for the Thickness of
the Mucous Membrane of an Alveolar Process" (hereunder "the '105
patent"), which is fully incorporated herein by reference,
discloses an ultrasonic method for measuring the thickness of the
mucous membrane in the region of the jawbone ridge. Neither the
'360 patent nor the '105 patent comprise any mechanism for scanning
the bone being examined. Neither patent provides an image of the
bone, nor any information regarding the internal structure of the
examined jawbone.
[0019] U.S. Pat. No. 5,564,423 entitled "Ultrasonic Measurement
System for the Determination of Bone Density and Structure"
(hereunder "the '423 patent"), which is fully incorporated herein
by reference, discloses an electronic system for measuring the
density and structure of bone, equipped with ultrasonic calipers
designed to be applied to a segment of the human body (for example,
a finger) containing bone tissue to be examined. The ultrasonic
calipers include a transmitting transducer and a receiving
transducer, which enable measuring TOF in the bone tissue based on
a through-transmission method. The system provides an indication of
the density and structure of the bone tissue based on the measured
TOF. Since the '423 patent relies on TOF measurement, it suffers
from the same impracticability and inaccuracy problems mentioned
above in connection to ABMS. Likewise, the '423 patent also does
not comprise any mechanism for scanning the examined bone tissue,
and does not provide the location and image of internal structures
within the bone tissue.
[0020] Thus, none of the above solutions provides an economic,
radiation free, real-time, chair-side imaging tool to the
implantologist. Ongoing monitoring of the drilling process allows
for depth and angulation corrections on the fly. There is thus a
widely recognized need for, and it would be highly advantageous to
have systems for ultrasonic imaging of a jaw, methods of use
thereof and coupling cushions suited for use in the mouth devoid of
the above limitations.
SUMMARY OF THE INVENTION
[0021] According to one aspect of the present invention there is
provided an improved ultrasonic imaging system constructed to
facilitate imaging of at least a portion of a jaw. The system
includes: (a) a probe, the probe includes at least one array of
ultrasonic transducers; (b) a position locator module designed and
constructed to be capable of defining a location of the probe in
six degrees of freedom and transmitting the definition to a central
processing unit; and (c) the central processing unit. The Central
processing unit (CPU) is capable of, by virtue of design and
configuration, (i) receiving from the probe digital data from each
of the ultrasonic transducers in the arrays; (ii) further receiving
from the position locator a location of the probe; and (iii)
transforming the digital data into an image of the at least a
portion of a jaw.
[0022] According to another aspect of the present invention there
is provided a method of producing an ultrasonic image of at least a
portion of a jaw. The method includes: (a) providing a probe, the
probe includes at least one array of ultrasonic transducers; (b)
defining a location of the probe in six degrees of freedom by means
of a position locator; (c) communicating the location to a central
processing unit; (d) transmitting an ultrasonic signal from at
least one of the transducers and receiving at least a portion of
the ultrasonic signal at least one of the transducers; and (e)
employing a central processing unit. The central processing unit
serves to; (i) receive a set of digital data pertaining to the
transmitting and receiving performed by the transducers of in the
arrays of the probe; (ii) further receive from the position locator
a location of the probe; and (iii) transform the digital data into
an image of the at least a portion of the jaw.
[0023] According to yet another aspect of the present invention
there is provided an ultrasonic coupling cushion, the cushion
includes an elastic container capable of retaining a coupling
medium wherein the elastic container is designed and constructed to
be insertable in a mouth of a subject.
[0024] According to further features in preferred embodiments of
the invention described below, the image is a three dimensional
image. The image preferably depicts mandibular Features such as
bones, teeth and nerve canals.
[0025] According to still further features in the described
preferred embodiments the probe is a mandibular probe designed and
constructed to facilitate imaging of at least a portion of a lower
jaw. The mandibular probe includes: (i) a first array of ultrasonic
transducers mounted upon a first wand, the first array of
ultrasonic transducers positionable distal to the lower jaw and
outside of a mouth; (ii) a second array of ultrasonic transducers,
the second array of transducers mounted upon a second wand, the
second array of ultrasonic transducers positionable proximal to the
lower jaw and inside of the mouth; and (iii) at least one
connective member. The connective member designed and constructed
to connect the first and second wands one to another and to allow
relative positioning thereof. The connective member includes an
assembly designed and constructed to attach the first and second
wands and facilitate translational motion of the wands with respect
to one another.
[0026] According to still further features in the described
preferred embodiments the probe is designed and constructed to
facilitate imaging of at least a portion of an upper jaw and
includes a single curved array of ultrasonic transducers mounted
upon a wand, the wand designed and constructed to be insertable
into a mouth of a patient.
[0027] According to still further features in the described
preferred embodiments the position locator module includes at least
one first position sensor located on the probe and at least one
second position sensor located on a head of a subject.
[0028] According to still further features in the described
preferred embodiments the position locator module includes a first
mechanical positioning mechanism designed and constructed to
position the probe and a retention means designed and constructed
to engage and retain a head (of a subject in a known position.
[0029] According to still further features in the described
preferred embodiments the system further includes an ultrasonic
coupling cushion, the cushion includes an elastic container capable
of retaining a coupling medium. The elastic container is designed
and constructed to be insertable in a mouth of a subject.
[0030] According to still further features in the described
preferred embodiments the image is a three dimensional image.
[0031] According to still further features in the described
preferred embodiments providing a probe includes providing a
mandibular probe designed and constructed to facilitate imaging of
at least a portion of a lower jaw and includes: (i) providing a
first array of ultrasonic transducers mounted upon a first wand,
the first array of ultrasonic transducers positionable distal to
the lower jaw and outside of a mouth; (ii) providing a second array
of ultrasonic transducers, the second array of transducers mounted
upon a second wand, the second array of ultrasonic transducers
positionable proximal to the lower jaw and inside of the mouth;
(iii) providing at least one connective member, the connective
member designed and constructed to connect the first and second
arrays one to another and to allow relative positioning thereof.
The connective member includes an assembly designed and constructed
to attach the first and second wands and facilitate translational
motion of the wands with respect to one another.
[0032] According to still further features in the described
preferred embodiments providing a probe includes providing a
maxillary probe designed and constructed to facilitate imaging of
at least a portion of an upper jaw and includes and includes a
single curved array of ultrasonic transducers mounted upon a wand,
said wand designed and constructed to be insertable into a mouth of
a patient.
[0033] According to still further features in the described
preferred embodiments the coupling cushion further includes the
coupling medium. The coupling medium is selected from the group
consisting of water, an aqueous solution, a gel and a polymer
solution.
[0034] According to still further features in the described
preferred embodiments the elastic container further includes
attachment device designed and constructed to engage and retain at
least a portion of an ultrasonic probe. The attachment device may
be, for example a sleeve, a pocket or series of loops. The
attachment device includes at least one hole to accept an
ultrasonic probe.
[0035] The present invention discloses a method and apparatus for
non-invasive ultrasonic imaging of hard tissue.
[0036] According to the present invention, there is provided in a
first embodiment, a method of ultrasonic imaging of a biological
tissue, comprising the steps of scanning the biological tissue with
ultrasonic energy transmitted from and received at a plurality of
known transmittal and reception locations about the biological
tissue, to obtain a corresponding plurality of sets of digital
data, and processing the sets of digital data to produce an image
of a cross-section of the biological tissue.
[0037] According to yet another feature of the first embodiment of
the method of the present invention, the step of scanning includes
applying at least one scanning mode selected from the group
consisting of through-transmission mode and pulse-echo mode.
[0038] According to yet another feature of the first embodiment of
the method of the present invention, the step of scanning includes
using at least one scanning mechanism selected from the group
consisting of mechanical scanning and electronic scanning.
[0039] According to yet another feature of the first embodiment of
the method of the present invention, the step of scanning includes
the substeps of disposing at least one ultrasonic transducer in
proximity to the biological tissue, determining a location of the
at least one ultrasonic transducer, transmitting ultrasonic energy
into the biological tissue using the at least one ultrasonic
transducer, the ultrasonic energy being reflected from the
biological tissue, and receiving the ultrasonic energy reflected
from the biological tissue using the at least one ultrasonic
transducer.
[0040] According to additional features in the first embodiment of
the method of the present invention, the method further includes
changing the location of the at least one ultrasonic transducer,
and repeating the steps of: determining a location of the at least
one ultrasonic transducer, transmitting ultrasonic energy into the
biological tissue using the at least one ultrasonic transducer, the
ultrasonic energy being reflected from the biological tissue, and
receiving the ultrasonic energy reflected from the biological
tissue using the at least one ultrasonic transducer for a desired
number of repetitions.
[0041] According to a second embodiment of the method of the
present invention, the step of scanning includes the substeps of
disposing a plurality of ultrasonic transducers in proximity to the
biological tissue, determining a location of each of the plurality
of ultrasonic transducers, transmitting ultrasonic energy into the
biological tissue, using at least one first ultrasonic transducer
selected from the plurality of ultrasonic transducers, the
ultrasonic energy propagating through the biological tissue, and
receiving the through propagating ultrasonic energy, using at least
one second ultrasonic transducer selected from the plurality of
ultrasonic transducers, the at least one second ultrasonic
transducer being different from the at least one first ultrasonic
transducer.
[0042] According to additional features in the second embodiment of
the method of the present invention, the method further includes
the substeps of varying the selection of at least one ultrasonic
transducer from the group consisting of the at least one first
ultrasonic transducer and the at least one second ultrasonic
transducer, and repeating the steps of: determining a location of
each of the plurality of ultrasonic transducers, transmitting
ultrasonic energy into the biological tissue, using at least one
first ultrasonic transducer selected from the plurality of
ultrasonic transducers, the ultrasonic energy propagating through
the biological tissue, and receiving the through propagating
ultrasonic energy, using at least one second ultrasonic transducer
selected from the plurality of ultrasonic transducers, the at least
one second ultrasonic transducer being different from the at least
one first ultrasonic transducer, for a desired number of
repetitions.
[0043] According to a third embodiment of the method of the present
invention, the step of scanning includes the substeps of: (a)
disposing a plurality of ultrasonic transducers in proximity to the
biological tissue, (b) determining a location of each of the
plurality of ultrasonic transducers, (c) transmitting ultrasonic
energy into the biological tissue, using at least one ultrasonic
transducer selected from the plurality of ultrasonic transducers,
the ultrasonic energy being reflected from the biological tissue,
(d) receiving the ultrasonic energy reflected from the biological
tissue using the same at least one selected ultrasonic transducer
used for transmitting, (e) varying the selection of the at least
one selected ultrasonic transducer used for transmitting and
receiving the ultrasonic energy; and repeating steps (c) through
(e) for a desired number of repetitions.
[0044] According to the present invention, the substep of
generating a spectral function further includes the substep of
representing each spectral function by a first representative
value, all such first representative values forming a first array
of representative values.
[0045] According to another feature in the method of the present
invention, the first representative value is selected from the
group consisting of a minimum, a maximum, an average, a root mean
square (RMS), and a total sum of amplitudes.
[0046] According to yet another feature in the method of the
present invention, the substep of representing each spectral
function by a first representative value further includes the
substeps of identifying at least one distinct local variability in
the first array of representative values, and calculating the value
of a dimension related to an internal structure within the
biological tissue, based on the at least one distinct local
variability.
[0047] According to yet another feature in the method of the
present invention, the dimension related to an internal structure
within the biological tissue is selected from the group consisting
of a width, a length, a depth, a height, a diameter and a
thickness.
[0048] According to yet another feature in the method of the
present invention, the internal structure includes a cavity.
[0049] According to yet another feature in the method of the
present invention, the step of generating a spectral function
further includes the substeps of representing each spectral
function by a second representative value, all such second
representative values forming a second array of representative
value, and producing a synthetic array of representative values,
based on the first and second arrays of representative values.
[0050] According to yet another feature in the method of the
present invention, the step of generating a spectral function
further includes the substeps of identifying at least one distinct
local variability in the synthetic array of representative values,
and calculating the value of a dimension related to an internal
structure within the biological tissue, based on the at least one
distinct local variability.
[0051] According to yet another feature in the method of the
present invention, the substep of representing each spectral
function by a first representative value further includes the
substeps of identifying at least one extreme value in the first
array of representative values, measuring a first attenuation
coefficient inside the biological tissue, measuring a second
attenuation coefficient inside an internal structure within the
biological tissue, measuring the value of a first dimension related
to the biological tissue, and calculating the value of a second
dimension related to the internal structure, based on the at least
one identified extreme value, the first attenuation coefficient,
the second attenuation coefficient, and the value of the first
dimension.
[0052] According to the present invention, in a fourth embodiment
of the method, the step of processing includes the substeps of
deriving, from each of the sets of digital data, a property value
related to an ultrasonic property of the biological tissue,
measuring, for each of the sets of digital data, a dimension value
of a dimension related to the biological tissue and to same set of
digital data, and calculating, for each of the sets of digital
data, a set ratio between the property value and the dimension
value.
[0053] According to the present invention, in the fourth embodiment
of the method, the step of processing further includes the substeps
of forming an array of ratios based on the set ratios calculated
for all the sets of digital data, identifying at least one distinct
local variability in the array of ratios, and calculating the value
of a dimension related to an internal structure within the
biological tissue, based on the at least one identified distinct
local variability.
[0054] According to the present invention, in the various
embodiments of the method, the step of processing includes
deriving, from each of the sets of digital data, at least one value
related to an ultrasonic property of the biological tissue.
[0055] According to the present invention, in the various
embodiments of the method the ultrasonic property includes
ultrasonic attenuation.
[0056] According to the present invention, in the various
embodiments of the method, the step of processing includes the
substep of generating, for each of the sets of digital data, a
spectral function of the corresponding to the received ultrasonic
energy.
[0057] According to the present invention, in the various
embodiments of the method, the substep of generating a spectral
function includes applying a fast Fourier transform (FFT)
algorithm.
[0058] According to the present invention, in the various
embodiments of the method, the step of processing includes applying
a Radon transform algorithm.
[0059] According to one feature of all embodiments of the method of
the present invention, the biological tissue includes a jaw.
[0060] According to another feature of all embodiments of the
method of the present invention, the biological tissue includes a
bone.
[0061] According to yet another feature of all embodiments of the
method of the present invention, the bone is selected from the
group consisting of a mandible and a maxilla.
[0062] According to the present invention, there is provided an
apparatus for ultrasonic imaging of a biological tissue, comprising
means for scanning the biological tissue with ultrasonic energy
from a plurality of transmittal and reception locations about the
biological tissue, means for determining the transmittal and
reception locations, means for generating a plurality of sets of
digital data, the sets of digital data representing parameters of
the ultrasonic energy at each of the plurality of transmittal and
reception locations, and means for processing the plurality of sets
of digital data to produce a cross-sectional image of the
biological tissue.
[0063] The present invention successfully addresses the
shortcomings of the presently known configurations by providing
systems including specially configured oral ultrasonic probes
suitable for use in the mouth as well as coupling cushions for use
with these probes and methods for their use.
[0064] Implementation of the method and system for ultrasonic
imaging of the jaw of the present invention involves performing or
completing selected tasks or steps manually, automatically, or a
combination thereof. Moreover, according to actual instrumentation
and equipment of preferred embodiments of the method and system of
the present invention, several selected steps could be implemented
by hardware or by software on any operating system of any firmware
or a combination thereof. For example, as hardware, selected steps
of the invention could be implemented as a chip or a circuit. As
software, selected steps of the invention could be implemented as a
plurality of software instructions being executed by a computer
using any suitable operating system. In any case, selected steps of
the method and system of the invention could be described as being
performed by a data processor, such as a computing platform for
executing a plurality of instructions.
BRIEF DESCRIPTION OF THE DRAWINGS
[0065] The invention is herein described, by way of example only,
with reference to the accompanying drawings. With specific
reference now to the drawings in detail, it is stressed that the
particulars shown are by way of example, and for purposes of
illustrative discussion of the preferred embodiments of the present
invention only, and are presented in the cause of providing what is
believed to be the most useful and readily understood description
of the principles and conceptual aspects of the invention. In this
regard, no attempt is made to show structural details of the
invention in more detail than is necessary for a fundamental
understanding of the invention, the description taken with the
drawings making apparent to those skilled in the art how the
several forms of the invention may be embodied in practice.
[0066] In the drawings:
[0067] FIG. 1 shows a high-level schematic sectional view of a
mandible;
[0068] FIG. 2a shows a low-level schematic sectional view of a
mandible;
[0069] FIG. 2b shows a sectional view of a mandible after the loss
of a tooth;
[0070] FIG. 2c shouts a sectional view of a mandible with a drill
drilling into the alveolar ridge;
[0071] FIG. 3a shows a schematic sectional view a maxilla;
[0072] FIG. 3b shows a sectional view of a maxilla after the loss
of a tooth;
[0073] FIG. 4 is an example of a panoramic x-ray image of a
mandible and a maxilla;
[0074] FIG. 5a is an example of a sectional CT image of a toothless
mandible;
[0075] FIG. 5b is all example of a sectional CT image of a
toothless maxilla;
[0076] FIG. 6 illustrates a preferred embodiment apparatus of the
present invention;
[0077] FIG. 7 illustrates the preferred method of operation of the
preferred embodiment apparatus of the present invention;
[0078] FIGS. 5a-8c illustrate an example of a vertical, parallel
scanning movement;
[0079] FIGS. 9a-9c illustrate an example of a horizontal, parallel
scanning movement;
[0080] FIG. 10 illustrates an example of three spectral functions
of an ultrasonic signal transmitted through a jaw;
[0081] FIG. 1I illustrates an alternative embodiment apparatus of
the present invention;
[0082] FIG. 12 illustrates the preferred method of operation of the
alternative embodiment apparatus of the present invention;
[0083] FIGS. 13a-13c illustrate an example of a vertical scanning
movement;
[0084] FIGS. 14a-14b illustrate an example of a horizontal scanning
movement;
[0085] FIG. 15 illustrates an example of two travel paths of
ultrasonic pulses propagating through a maxilla;
[0086] FIG. 16 illustrates yet another alternative embodiment
apparatus of the present invention;
[0087] FIG. 17 illustrates still another alternative embodiment
apparatus of the present invention;
[0088] FIG. 18 illustrates the preferred method of operation of
another alternative embodiment apparatus of the present
invention;
[0089] FIG. 19 is a cartoon illustrating positioning of components
of various embodiments of a system according to the present
invention relative to the jaws and head of a patient;
[0090] FIG. 20 is a schematic representation of communication
between components of various embodiments of a system according to
the present invention;
[0091] FIG. 21 is a is a cross sectional view of a mandibular probe
according to the present invention;
[0092] FIGS. 22a and 22b illustrate a maxillary probe according to
the present invention;
[0093] FIG. 23 is a flow diagram illustrating events associated
with performance of methods according to the present invention;
[0094] FIGS. 24a, 24b and 24c illustrate sample image outputs of
portions of a jaw according to various embodiments of the present
invention;
[0095] FIG. 24d compares an image produced by the present invention
to an image of the same object produced using X-ray technology;
and
[0096] FIG. 25 is a perspective view one embodiment of a coupling
cushion according to the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0097] The principles and operation of systems, methods and devices
according to the present invention may be better understood with
reference to the drawings and accompanying descriptions.
[0098] Before explaining at least one embodiment of the invention
in detail, it is to be understood that the invention is not limited
in its application to the details of construction and the
arrangement of the components set forth in the following
description or illustrated in the drawings. The invention is
capable of other embodiments or of being practiced or carried out
in various ways. Also, it is to be understood that the phraseology
and terminology employed herein is for the purpose of description
and should not be regarded as limiting.
[0099] Referring now to the drawings FIGS. 19 and 20 illustrate the
arrangement of important operational components of systems 520
according to the present invention with respect to the head 527 and
mouth 529 of a patient. The improved ultrasonic imaging system 520
is constructed to facilitate imaging of at least a portion of a
jaw. The jaw may be either upper jaw (maxilla) 521 or lower jaw
(mandible) 523 which are represented in cross section in FIG. 19 as
rectangles for simplicity. System 520 includes a probe 522 which
includes at least one array of ultrasonic transducers (e.g. 524 or
526; see also FIGS. 21 and 22). Probe 522 further includes a
position locator module 540 designed and constructed to be capable
of defining a location of probe 522 in six degrees of freedom and
transmitting the definition to a central processing unit (CPU) 536.
System 520 further includes-CPU 536. CPU 536 is capable of, by
virtue of design and configuration performing several functions.
These functions include, but are not limited to, receiving from the
probe digital data from each of the ultrasonic transducers arrays
(e.g. 524 or 526), further receiving position locator module 540 a
location of probe 522 and transforming the digital data into an
image of the at least a portion of the jaw 521 or 523. CPU 536
displays the image on a display 538 such as, for example a CRT,
LCD, or Plasma screen display. The displayed image may be color or
greyscale according to various preferred embodiments of the
invention. CPU 536 is preferably further equipped with at least one
input device such as a keyboard, touchscreen, mouse, trackpad/ball
or microphone. The input device permits an operator to, for
example, manipulate the image on display 538 (e.g. control size,
brightness or contrast) and/or to control components of system 520
such as transducers 524 and/or 526 of probe 522 and/or mechanical
positioning mechanism 546 of probe 522.
[0100] The displayed image is preferably three dimensional image
prepared by CPU assisted assembly of a series of planar images
acquired by probe 522. The image preferably depicts features such
as bones, teeth and nerve canals (see FIGS. 24a,b,c and d.) FIG.
24d clearly indicates that images acquired by ultrasound are more
informative than those acquired by prior art X-ray methods.
[0101] According some preferred embodiments of system 520, probe
522 is a mandibular probe designed and constructed to facilitate
imaging of at least a portion of a lower jaw 521. The mandibular
probe 522 (see FIG. 21) includes a first array 524 of ultrasonic
transducers mounted upon a first wand 530. First array 524 of
ultrasonic transducers is positionable distal to lower jaw 521 and
outside of a mouth 529. Mandibular probe 522 further includes a
second array 526 of ultrasonic transducers mounted upon a second
wand 532. Second array 526 of ultrasonic transducers is
positionable proximal to lower jaw 521 and inside of mouth 529.
Mandibular probe 522 further includes at least one connective
member 528 (534). The connective member is designed and constructed
to connect the first and second wands 530 and 532 one to another
and to allow relative positioning thereof. The connective member
528 includes an assembly designed and constructed to attach the
first and second wands and facilitate translational motion (534) of
the wands with respect to one another. In the pictured embodiment,
complementary arcuate teeth 533 and gears 531 are employed to
facilitate translational motion (534) of the wands 530 and 532 with
respect to one another although any known mechanical, electrical or
robotic means might be employed without significantly altering the
invention. In the pictured embodiment cable 535 is employed for
data transfer to CPU 536 although transfer via microwave, RF or
infrared may alleviate the requirement for a physical connection
between components of system 520.
[0102] According to alternate preferred embodiments of the
invention, probe 522 (shown in greater detail in FIGS. 22a and b)
is designed and constructed to facilitate imaging of at least a
portion of an upper jaw (maxilla; 523) and includes a single curved
array 524 of ultrasonic transducers mounted upon a wand 530 which
is designed and constructed to be insertable into a mouth 529 of a
patient. Transducers 524 are preferably mounted on an inner surface
of curved wand 530 which can transverse, or straddle, maxilla 523
at a chosen point. It has been determined that a few standard
sizes, preferably 9 or fewer, more preferably 6 or fewer, more
preferably 3 or fewer, of maxillary probe 522 can permit imaging of
maxilla of virtually all portions of maxilla S23 of virtually all
patients. This relieves the requirement for a positioning mechanism
534 employed in the mandibular configuration of probe 522.
[0103] According to some preferred embodiments, the position
locator module 540 includes at least one first position sensor 542
located on probe 522 and at least one second position sensor 544
located on a head 527 of a subject. In mandibular probe 522 (FIG.
19), first position sensor 542 includes two position sensors, one
on each of wands 530 and 532.
[0104] Alternately, but also preferably, position locator module
540 includes a first mechanical positioning mechanism 546 designed
and constructed to position probe 522 and a retention means 548
(represented as a grey oval in FIG. 19) designed and constructed to
engage and retain a head of a subject in a known position which CPU
536 can employ as a basis for calculation. Retention means 548 may
be of the type commonly employed during ophthalmologic examinations
and may optionally be equipped with a second positioning mechanism
(not shown). Typically, a patient presses forehead and chin into
retention means 548 during the examination. As an example, a mini
BIRd positioner (Ascension Technology Corporation) might be
employed. Incorporation of such a commercially available device
into the contect of the present invention will be readily
accomplished by one of ordinary skill in the alt.
[0105] Preferably system 520 further includes an ultrasonic
coupling cushion 550 (see FIG. 25). Cushion 550 includes an elastic
container 552 capable of retaining a coupling medium 554 therein.
Elastic container 552 is designed and constructed to be insertable
in a mouth of a subject and will typically have a thickness of 2 to
20 mm. Cushion 550 is positioned between probe 522 and jaw 521 or
523. Cushion 550 obviates the need for conductive fluid or gel
inside the mouth so that an image may be acquired without requiring
the patient to spit or rinse. Further, cushion 550 may be used
between probe 522 the face in the case of a mandibular probe which
has one array of transducers 524 located outside mouth 529. This
eliminates the need to apply conductive gel to the face which may
be especially important to patients with beards. Additional details
of the configuration of cushion 550 are provided hereinbelow.
[0106] The invention is further embodied by a method 560 (FIG. 23)
of producing an ultrasonic image of at least a portion jaw 521 or
523. Method 560 includes providing 562 a probe 522. According to
various embodiments of the invention, this may include providing
530 a mandibular probe 522 as detailed hereinabove or providing 582
a maxillary probe 522 as detailed hereinabove. In any case, probe
522 includes at least one array of ultrasonic transducers 524
and/or 526. Method 560 further includes defining 564 a location of
probe 522 by means of position locator module 540 as detailed
hereinabove. Method 560 further includes communicating 566 the
location to CPU 536. Method 560 further includes transmitting 568
an ultrasonic signal from at least one of the transducers and
receiving at least a portion of the ultrasonic signal at least one
of the transducers. Method 560 further includes employing CPU 536
for data processing. CPU 536 serves to receive 572 a set of digital
data pertaining to the transmitting and receiving performed by the
transducers in arrays 524; 526 of probe 522. CPU 536 further serves
to receive 574 from position locator 540 a location the probe 522.
CPU 536 further serves to transform the digital data into an image
of the at least a portion of jaw 521 or 523. Preferably the image
is a three dimensional image. Preferably, method 560 further
includes attaching coupling cushion 550 to at least a portion of
probe 522.
[0107] The present invention is further embodied by ultrasonic
coupling cushion 550 (FIG. 25) which includes elastic container 552
capable of retaining coupling medium 554. Elastic container 552 is
designed and constructed to be insertable in a mouth of a subject.
Preferably, container 552 has a thickness of 1 to 20 mm and an area
only slightly larger than that occupied by array of transducers 524
or 526. Preferably coupling cushion 550 further coupling medium 554
which may be, for example, water, an aqueous solution, a gel or a
polymer solution.
[0108] Preferably elastic container 552 further includes attachment
device 556 designed and constricted to engage and retain at least a
portion of probe 522. FIG. 22b illustrates use of two attachment
devices 556 (dotted lines) to position container 552 probe 522.
Attachment device 556 may be, for example a sleeve, a pocket or
series of loops. Attachment device 556 includes at least one hole
558 to accept at least a portion of probe 522. Attachment device
556 may be integrally formed with, or attached to, container 552.
During use, array of transducers 526 preferably resides in
attachment device 556 ultrasonic signals (whether transmitted or
received) must pass through elastic container 552 and coupling
medium 554 contained therein. Cushion 550 is gently pressed against
jaw 521 or 523 during use. This may be accomplished by correct
positioning of probe 522 with respect to jaw 521 or 523. According
to some embodiments of the invention, valve 553 allows filling of
container 552 with coupling medium 554.
[0109] FIGS. 24a, b, c and d illustrate images produced according
to various preferred embodiments of the invention. Different images
are produced by altering the configuration of CPU 536 and the way
in which arrays of transducers 524 (and optionally 526) are
operated. A brief, non limiting, explanation of several common
imaging technologies suited for use in the context of the present
invention is provided
[0110] Synthetic Aperture Focusing Technique (SAFT)
[0111] A synthetic aperture (SA) image, synthesized from
reflections collected at both Outside array 524 and Inside array
526 allows depiction of the contour of the bone based on the "first
reflection", i.e. the bounding reflection line. The image can also
reveal reflectors inside the bone such as the mandibular canal,
root canals, or implants. FIG. 24a is an example of an image
produced using SAFT.
[0112] SAFT+Contour Detection
[0113] The contour of the bone is computed from the SA image rid,
given on polar coordinates C and 0. First a matching filter is used
to find points along the bone surface, and second a Fourier
polynomial is fitted to the points in an iterative optimization. An
improved image results. FIG. 24b is an example of an image produced
using SAFT+Contour Detection.
[0114] Computerized Tomography (CT)
[0115] Computerized Tomography (CT) of Time Of Flight (TOF) allows
computing the sound velocity in jawbone 521 or 523. In order to
increase the penetration energy CPU 536 employs a scan program
which uses several adjacent emitters (usually 2 or 3) for each
A-scan. The emitters are electronically focused using phased al-ray
electronics. All available scans in through transmission mode are
used for solution of the inverse problem.
[0116] For Each A-scan the TOF is detected from the first signal
with amplitude larger than the noise threshold value. If this TOF
is smaller than the TOF calculated for signals passing in water,
then the measurement is valid for the tomography calculation.
[0117] The solution takes into account the contour of the bone,
thus reducing the number of image pixels to be resolved, i.e. the
degrees of freedom. The method of solution is iterative in two
steps. In the first step the radiation is assumed to propagate in
straight lines, while in the second step the propagation line is
corrected for the differences in the sound velocity in bone that
were calculated in the first step. FIG. 24c shows the results of
the first step oil the loft (1), and the second step on the right
(2). The correction method has two advantages over straight-line
tomography. First, it results in more homogeneous areas, and
second, the location of objects such as the canal is more
correct.
[0118] Red color corresponds to high velocity (3 mm/.mu.s), and
Blue corresponds to low velocity (1.5 mm/ps as the sound velocity
in water). In compact bone the velocities are .about.2.5-3.0
mm/.mu.s while in trabecular bone the velocities are .about.1.5-2.0
mm/.mu.s. Therefore the velocity image allows differentiating
between the cortical and trabecular bones. Also, the nerve canal,
filled with "water", can be noticed. FIG. 24d shows the resulting
TOF tomography image in comparison with an image produced by X-ray
mechanical tomography in the same location for the same patient
[0119] The present invention discloses a method and apparatus for
non-invasive ultrasonic imaging of hard tissue.
[0120] Referring now to FIG. 6, a preferred embodiment of the
present invention, designated 100, will be described. Apparatus 100
is an apparatus for non-invasive ultrasonic imaging of hard tissue.
Apparatus 100 comprises a controller 102 coupled to a
pulser.backslash.receiver 104 and to a location monitoring device
116. Pulser.backslash.receiver 104 is coupled to a first transducer
106, to a second transducer 108 and to an analog-to-digital
converter (ADC) 110. ADC 110 is coupled to a computer 112, which is
coupled to a display device 114. Location monitoring device 116 is
coupled to first transducer 106, to second transducer 108, and to
computer 112.
[0121] Referring now to FIG. 7, the method of operation of
apparatus 100 will be described. Apparatus 100 operates according
to a through-transmission method, as follows. A user couples first
transducer 106 to an initial location on a surface of an organ
being examined, for example, on a first surface 32 of a mandible
30. First surface 32 can be, for example, a surface inside the
mouth cavity, such as the buccal or lingual gum surface of the jaw,
or a surface outside the mouth cavity, such as the surface of the
cheek or the chin. Alternatively, in case the jawbone is exposed
(e.g. by raising the mucoperiosteal flap) first transducer 106 can
be coupled directly to a bone surface of the jaw. In FIG. 7, for
example, first surface 32 is a toothless buccal gum surface,
although the same procedure can be performed on a surface under
which a tooth is present.
[0122] The user couples second transducer 108 to an initial
location on a surface opposite to transducer 106. In FIG. 7, for
example, second transducer 108 is coupled to a second surface 32'
of mandible 30, which is opposite to first surface 32 to which
first transducer 106 is coupled. If, for example, first surface 32
is the buccal gum surface of mandible 30, then second surface 32'
can be the lingual surface thereof; if first surface 32 is the
lingual surface of mandible 30, then second surface 32' can be, for
example, the buccal gum surface or cheek surface opposite thereto.
Like first transducer 106, second transducer 108 can be coupled
directly to a bone surface of the jaw, in case the jawbone is
exposed.
[0123] In order to improve receipt by second transducer 108 of
ultrasonic signals emitted by first transducer 106, the user
preferably aligns the two transducers so that they face one another
on a predetermined common axis CX.sub.106. In order to further
improve penetration of ultrasound signals into mandible 30, the
user applies a coupling material 74 between first transducer 106
and first surface 32, and between second transducer 108 and second
surface 32'. In some cases, the fluids naturally present in the
mouth of the patient (e.g. saliva) will be sufficient to serve as
coupling material 74. In other cases, the user can use another
material for coupling, for example, a non-toxic ultrasound coupling
gel.
[0124] When the transducers are properly coupled, the user starts
the operation of apparatus 100 using controller 102. The controller
commands location monitoring device 116 to determine the initial
location of first transducer 106 and the initial location of second
transducer 108. Device 116 determines the initial locations using a
conventional measuring method and sends the results to computer
112. The controller further commands pulser.backslash.receiver 104
to generate electrical pulses and to send them to first transducer
106. First transducer 106 converts the electrical pulses to
ultrasonic pulses and emits them toward first surface 32. The
emitted ultrasonic pulses partially penetrate first surface 32 via
coupling material 74. Some of the penetrating ultrasonic pulses
then travel inside mandible 30 through cortical bone layer 34,
trabecular bone 36, opposite cortical bone layer 34' and second.
(opposite) surface 32', eventually reaching second transducer 108
via coupling material 74. Second transducer 108 receives ultrasonic
pulses which propagated through mandible 30, converts them into
analog electrical pulses and sends the electrical pulses to ADC 110
via pulser.backslash.receiver 104. The ADC samples the electrical
pulses which represent the received pulses and sends these samples
to computer 112. The computer records, as a first set of results,
the samples which represent the received pulses along with the
initial location of the emitting transducer and the initial
location of the receiving transducer.
[0125] The user scans mandible 30, for example, by moving first
transducer 106 along first surface 32 whilst also moving second
transducer 108 along second surface 32' in parallel to the first
transducer. FIGS. 8a-8c illustrate an example of a vertical,
parallel scanning movement. FIG. 8a shows the initial locations of
transducers 106 and 108 which are relatively far from mandibular
canal 38. FIG. 8b shows the locations of the two transducers after
having been moved, in parallel, approximately halfway closer to
mandibular canal 38. FIG. 8c shows the locations of the two
transducers after having been moved further in parallel, so that
mandibular canal 38 lies on the ultrasonic travel path (depicted as
a broken-line arrow) between the two transducers. FIGS. 9a-9b
illustrate an example of a horizontal, parallel scanning movement.
First transducer 106 is coupled to alveolar ridge 40 of mandible 30
and second transducer 108 is coupled to the floor of the mandible,
opposite to and facing first transducer 106. FIG. 9a shows the
initial locations of the transducers. The transducers are initially
placed so that the travel path (depicted as a broken-line arrow) of
ultrasonic pulses does not pass through mandibular canal 38. FIG.
9b shows the location of the two transducers after having been
moved, in parallel, toward the middle of the jaw, so that
mandibular canal 38 lies on the path between first transducer 106
and second transducer 108.
[0126] Alternatively, instead of a parallel scanning motion (FIGS.
8 and 9), the user may also scan mandible 30 by moving only one
transducer whilst the other transducer remains stationary, by
moving the two transducers; in opposite directions or any other
desired scanning pattern. Apparatus 100 can further be equipped
with automatic mechanical scanning means, for example, a slidable
mount to which one or both of the transducers are attached and
which is programmed to execute a desired scanning pattern.
Alternatively, apparatus 100 can be equipped with electronic
scanning means, for example, an array of transducers instead or in
addition to transducer 106 and.backslash.or transducer 108.
[0127] During the scanning process, ADC 110 samples the ultrasonic
pulses received at each new location of the transducers, and
computer 112 keeps recording sets of samples along with
corresponding locations of the transducers. Computer 112 is further
programmed to determine certain physical characteristics of the
hard tissue being examined, based on an analysis of the recorded
sets.
[0128] When ultrasonic pulses travel inside hard tissue, they often
pass through layers, areas and.backslash.or internal structures
which possess different acoustic properties.
[0129] The difference between acoustic properties of an internal
structure within hard tissue on one hand, and acoustic properties
of the proximate surroundings of the internal structure on the
other hand, makes it possible for apparatus 100 to detect, locate,
measure and image such an internal structure within hard tissue.
For example, when the hard tissue being examined by apparatus 100
is a mandible, penetrating ultrasonic pulses will sometimes
propagate through mandibular canal 38 on their path from first
transducer 106 to second transducer 108. This will be the case, for
example, if mandibular canal 38 lies on the path between the two
transducers (as illustrated in FIG. 8c). According to the teachings
of the present invention, mandibular canal 38 possesses different
acoustic properties than trabecular 36 and cortical bone 34. For
example, since the mandibular canal is typically filled with
fluids, it will sometimes be characterized by lower ultrasonic
attenuation than cortical and trabecular bone. In other cases, the
geometry of the mandibular canal may actually cause penetrating
ultrasonic pulses to scatter, eventually causing higher attenuation
than cortical and trabecular bone. The present invention therefore
teaches that when, during the scanning process, mandibular canal 38
is situated on the path between first transducer 106 and second
transducer 108 (e.g. FIGS. 8c and 9b), consequently computer 112
will be able to detect a local change (increase or decrease) in
amplitude of the received and sampled pulses.
[0130] Hence, it is a particular feature of apparatus 100 that it
detects and locates an internal structure within hard tissue (e.g.
the mandibular canal in a mandible), by detecting a local change in
the amplitude of penetrating ultrasonic pulses. When computer 112
detects such a local change in the amplitude, it will notify the
user (e.g. by issuing an indication on display 114) that an
internal structure lies on the ultrasonic travel path between first
transducer 106 and second transducer 108.
[0131] It is another particular feature of apparatus 100 that it
Can measure the depth of an internal structure within hard tissue,
such as the depth of the mandibular canal in a mandible, based on
amplitude measurements. By "depth" is meant the distance from a
surface of the organ being examined to the internal structure of
interest. For purposes of illustration hereunder, horizontal depth
L, means the horizontal distance from surface 32 to the nearest
border of mandibular canal 38, and vertical depth L, means the
vertical distance from alveolar ridge 40 to the nearest border of
mandibular canal 38 (see FIGS. 8c and 9c). The method of operation
of apparatus 100 in measuring the depth of an internal structure
within the hard tissue, for example, the depth of mandibular canal
38 within mandible 30, is as follows. The transducers scan mandible
30 according to the method described heretofore. As soon as
computer 112 first detects a characteristic change in the amplitude
of penetrating ultrasonic pulses, it means that the pulses have
first met mandibular canal 38 on their path from first transducer
106 to second transducer 108. Since the computer receives from
location monitoring device 116 the location of the transducers at
any given moment, the computer can therefore calculate the depth of
mandibular canal as follows. In case of vertical scanning (FIGS.
8a-8c), vertical depth L.sub.y will be calculated as the vertical
distance from alveolar ridge 40 to the location of the transducers
which first introduced a characteristic amplitude change.
Similarly, in case of horizontal scanning (FIGS. 9a-9c), horizontal
depth L.sub.x will be calculated as the horizontal distance from
surface 32 to the location of the first characteristic amplitude
change. The measured depth will then be displayed on display
114.
[0132] It is yet another particular feature of apparatus 100 that
it can measure the diameter of an internal structure of interest
within hard tissue, for example, the diameter of mandibular canal
38 within mandible 30, based on amplitude measurements. The borders
of mandibular canal 38 are usually elliptic rather than round (see
FIG. 5a), and therefore the diameter may differ depending on the
direction from which it is measured. For purposes of illustration
hereunder, horizontal diameter D.sub.x means the diameter which
lies approximately on the horizontal axis of the jaw, and vertical
diameter D.sub.y means the diameter which lies approximately on the
vertical axis thereof (see FIGS. 8c and 9c). The method of
operation of apparatus 100 in measuring the diameter of an internal
structure within hard tissue, for example, the diameter of
mandibular canal 38 in mandible 30, is as follows. The transducers
scan mandible 30 according to the method described heretofore. When
measuring horizontal diameter D, horizontal scanning (FIG. 9) will
be performed, and when measuring vertical diameter D.sub.y vertical
scanning (FIG. 8) will be performed. As soon as computer 112 first
detects a characteristic change in the amplitude of penetrating
ultrasonic pulses, it means that the pulses have first met
mandibular canal 38 on their path from first transducer 106 to
second transducer 108. Subsequently, when amplitude returns to its
level prior to the characteristic change, it means that the
penetrating ultrasonic pulses no longer pass through mandibular
canal 38. Computer 112 then calculates and displays the diameter of
mandibular canal 38 based on the detected borders of the canal and
on location information supplied by location monitoring device
116.
[0133] It is yet another particular feature of apparatus 100 that
it can detect and locate an internal structure within hard tissue,
for example mandibular canal 38 within mandible 30, based on
spectral function analysis. Transducers 106 and 108 scan mandible
30, and ADC 110 sends to computer 112 samples of the received
ultrasonic pulses, all as explained hereinabove. Computer 112
processes the samples and produces, for each pair of locations of
the transducers, a spectral function representing ultrasonic pulses
emitted from and received at those locations. The spectral
functions can be produced, for example, using a known Fast Fourier
Transform (FFT) algorithm. The computer records, for each given
location of the transducers, a set containing the spectral function
of the received ultrasonic pulses along with the corresponding
location of the transducers. Computer 112 can then analyze various
characteristics of the spectral functions of the received
ultrasonic pulses to determine the location of an internal
structure within the hard tissue being examined. For example, it is
known in the art that if an ultrasonic signal propagates through a
medium which causes attenuation, the energy of the signal will be
concentrated in a lower frequency range than in the original signal
In general, a higher level of attenuation will cause a greater
frequency shift Ass mentioned heretofore, the present invention
teaches that mandibular canal 38 often causes a different level of
attenuation than cortical 34 and trabecular bone 36 around it. It
therefore follows that the frequency spectrum of ultrasonic pulses
received by second transducer 108 after having traversed mandible
30 via mandibular canal 38 (FIGS. 8c and 9b), will often be shifted
compared to the frequency spectrum of similar ultrasonic pulses
which did not travel through the mandibular canal.
[0134] FIG. 10 illustrates an example of three spectral functions
of the same ultrasonic signal: a first spectral function 210
represents the ultrasonic signal as it is originally emitted into a
jaw; a second spectral function 212 represents the same ultrasonic
signal as received after having propagated mainly through the
trabecular bone of the jaw (FIGS. 8a, 8b or 9a); and a third
spectral function 214 representing the same ultrasonic signal as
received after having traveled partly through trabecular bone and
partly through the mandibular canal (FIG. 8c or 9b). In this
example, the frequencies of peak amplitudes P.sub.212 and P.sub.214
of spectral functions 212 and 214 (i.e. of the attenuated received
signals) are lower than the frequency of peak amplitude P.sub.210
of spectral function 210 (i.e. of the originally emitted signal).
Furthermore, the example illustrates that the frequency of peak
amplitude P.sub.214 of ultrasonic pulses which traveled partly
through mandibular canal is higher than the frequency of peak
amplitude P.sub.212 of ultrasonic pulses which traveled mainly
through trabecular bone. Hence, when computer 112 detects a
characteristic frequency shift in the spectral function of received
ultrasonic pulses, it will notify the user (e.g. by issuing an
indication on display 114) that an internal structure lies on the
ultrasonic travel path between first transducer 106 and second
transducer 108.
[0135] It is yet another particular feature of apparatus 100 that
it can detect and locate an internal structure within hard tissue,
based on artificially amplified characteristics of the received
pulses, such characteristics being indicative of the internal
structure. In some cases, the effect of the internal structure of
interest on ultrasonic pulses traveling through it, may not be
easily distinguishable from the effect of the surrounding area.
This is the case, for example, when the level of attenuation inside
mandibular canal 38 is nearly equal to the level of attenuation
inside cortical 34 and trabecular bone 36. In such cases, computer
112 may perform further manipulations on the samples which
represent the received ultrasonic pulses, in order to amplify
certain characteristics which enable detecting the internal
structure.
[0136] According to this method, after computer 112 obtains
spectral functions of ultrasonic pulses received in various
locations across mandible 30 (as explained hereinabove), the
computer processes the recorded spectral functions to determine a
discrete representative value for each spectral function. Such a
representative value can be, for example, the minimal, maximal,
average or root mean square (RMS) amplitude of each spectral
function, or the total sum of all amplitudes in each spectral
function, or any other predetermined representation criterion. As a
result, the computer obtains and records a first array of
representative values as a function of the locations of the
transducers across mandible 30. Following, the computer analyzes
the first array, in order to detect a distinct local variability in
the representative values. In case such distinct local variability
is found, the computer can conclude and notify the user (e.g. on
display 114) that the internal structure of interest is situated in
the locations corresponding, to the locally varying representative
values. If no such distinct local variability is detected, the
computer will proceed and obtain a second array of representative
values, which is based on a different representation criterion than
that of the first array. If the first array is, for example, an
array of the total sum of amplitudes, then the second array can be,
for example, an array of the RMS of amplitudes. The computer
analyzes the second array to find a distinct local variability
which indicates the presence of the internal structure of interest.
If again no such distinct local variability is detected, the
computer will perform a predetermined mathematical manipulation on
the first and.backslash.or second arrays. For example, the computer
can divide the first array by the second array to obtain a third,
synthetic array of representative values as a function of locations
across the mandible. The computer analyzes the third, synthetic
array to find a distinct local variability which indicates the
presence of the internal structure. Often the synthetic array will
be characterized by a distinct local variability, even though the
first and second arrays which formed the third array were not so
characterized. This is because certain mathematical manipulations
may amplify physical effects which indicate the presence of the
internal structure of interest. The computer may repeat the above
procedure a desired number of repetitions.
[0137] It is yet another particular feature of apparatus 100 that
it enables calculating the diameter of an internal structure within
hard tissue, based on analysis of the ratio between the amplitude
of received ultrasonic pulses and the attenuation coefficients
inside the organ being examined. According to this method, after
computer 112 obtains spectral functions of ultrasonic pulses
received in various locations across mandible 30 (as explained
hereinabove), the computer determines the minimal amplitude A.sub.1
of ultrasonic pulses received by second transducer 108 during the
scanning process, and the maximal amplitude A.sub.2 of such
pulses.
[0138] As previously taught herein, attenuation in mandibular canal
38 is typically different than in cortical 34 and trabecular bone
36. Where attenuation in the mandibular canal is lower than in
cortical and trabecular bone, minimal amplitude A.sub.1 will be
measured when penetrating ultrasonic pulses do not travel through
mandibular canal 38 (FIGS. 8a, 8b or 9a), whereas maximal amplitude
A.sub.2 will be measured when the pulses travel partly via
mandibular canal 38 (FIG. 8c or 9b). Horizontal width S.sub.x of
trabecular area 36 is approximately equal to the total horizontal
travel distance of ultrasonic pulses (in case of vertical
scanning). Similarly, the vertical width S.sub.y is approximately
equal to the total vertical travel distance of ultrasonic pulses
(in case of horizontal scanning). The attenuation coefficient
inside trabecular area 36, designated .gamma..sub.1, as well as the
attenuation coefficient inside mandibular canal 38 (approximately
equal to the attenuation coefficient in water) designated
.gamma..sub.2, are both measured using conventional means and are
fed into computer 112.
[0139] It is known in the art that the ratio between the amplitude
A of a received ultrasonic signal and the distance S traveled by
the ultrasonic signal inside a medium with an attenuation
coefficient y can be expressed by the following first equation:
A.sub.1.apprxeq.e.sup.-(.gamma..multidot.S)
[0140] Hence, the ratio between minimal amplitude A.sub.1 and
trabecular width S.sub.x can be expressed by the following second
equation:
A.sub.1.apprxeq.e.sup.-(.gamma..sub.1.multidot.S.sub.x)
[0141] And the ratio between maximal amplitude A.sub.2 and diameter
D.sub.x of mandibular canal 38 can be expressed by the following
third equation:
A.sub.2.apprxeq.e.sup.-(.gamma..sub.1.multidot.(S.sub.x-D.sub.x)+(.gamma..-
sub.2.multidot.D.sub.x))
[0142] If the third equation is divided by the second equation,
then the following fourth equation is obtained: 1 A 2 A 1 = ( 1 - 2
) D x
[0143] The above fourth equation can be solved for DN as expressed
by the following fifth equation: 2 D x = ( log A 2 A 1 ) ( 1 - 2
)
[0144] Thus, having acquired minimal and maximal amplitude
measurements A.sub.1 and A.sub.2 and attenuation coefficients
.gamma..sub.1 and .gamma..sub.2, computer 112 calculates and
displays on display 114 horizontal diameter D, of mandibular canal
38, using the above fifth equation. Vertical diameter D.sub.y can
be measured in a similar manner, based on minimal and maximal
amplitudes A.sub.1 and A.sub.2 measured vertically.
[0145] It is yet another particular feature of apparatus 100 that
it can detect and locate an internal structure within hard tissue
(e.g. sinal and.backslash.or nasal cavities in a maxilla), based on
analysis of the ratio between the travel distance and attenuation
of ultrasonic pulses within the hard tissue. Referring now to FIG.
15, this method will now be described. As explained hereinabove,
transducers 106 and 108 are coupled using coupling material 74 to
opposite surfaces of the organ being examined whilst facing each
other. For example, in FIG. 15 first transducer 106 is coupled to a
first surface 52 of a maxilla 50, and second transducer 108 is
coupled to a second surface 52' thereof. In order to ensure that
the transducers are facing each other (e.g. when the surface to
which first transducer 106 is coupled is not parallel to the
surface to which second transducer 108 is coupled), angular
transducers may be used. When the transducers are properly coupled,
the user starts the operation of apparatus 100 using controller
102. The controller commands location monitoring device 116 to
determine the initial locations of the transducers, and to further
determine the travel distance TD of ultrasonic pulses inside
maxilla 50. Location monitoring device 116 determines the
abovementioned factors Using conventional measuring means and sends
the measurements to computer 112. Controller 102 further commands
pulse.backslash.receiver 104 to operate electrical pulses and to
send them to first transducer 106 and to ADC 110. First transducer
106 converts the electrical pulses to ultrasonic pulses and emits
them toward first surface 52. ADC 110 samples the electrical pulses
which represent the emitted pulses and sends these samples to
computer 112. The emitted ultrasonic pulses partially penetrate
first surface 52 and then travel inside maxilla 50 eventually
reaching second transducer 108. Second transducer 108 receives
ultrasonic pulses which propagated through maxilla 50, converts
them into analog electrical pulses and sends the electrical pulses
to ADC 110 via pulser.backslash.receiver 104. The ADC samples the
electrical pulses which represent the received pulses and sends the
samples to computer 112. The computer records, as a first set of
results, the samples which represent the emitted pulses and the
samples which represent the received pulses along with the initial
locations of the transducers and the initial travel distance
TD:
[0146] The user scans maxilla 50 according to a desired scanning
pattern, for example, by moving first transducer 106 along first
surface 52 whilst also moving second transducer 108 along second
surface 52' in parallel to the first transducer. As mentioned
hereinabove, apparatus 100 can be equipped with automatic scanning
means which perform this action instead of the user, either
mechanically or electronically. During the scanning process, ADC
110 samples the ultrasonic pulses emitted and received at each new
location of the transducers, and computer 112 records sets of
samples, along with their corresponding transducer locations and
travel distance TD. The computer calculates, for each new location
of the transducers, a ratio R between ultrasonic attenuation and
travel distance.
[0147] According to the teachings of the present invention, ratio R
will remain approximately the same as long as penetrating
ultrasonic pulses do not encounter an internal structure which
causes higher or lower attenuation than its proximate surroundings
within the hard tissue, on their travel path from first transducer
106 to second transducer 108. However, if penetrating ultrasonic
pulses encounter such an internal structure, then ratio R will
necessarily change. FIG. 15 illustrates an example in which
ultrasonic pulses traveling inside maxilla 50 encounter sinal
and.backslash.or nasal cavities 60 on their travel path from first
transducer 106 to second transducer 108. Since sinal
and.backslash.or nasal cavities 60 are sometimes filled with air,
they may cause higher attenuation than cortical 54 and trabecular
bone 56. Thus, if ultrasonic pulses traverse cavities 60 vial
travel path TP.sub.1 and a travel distance TD.sub.1, then they will
suffer higher attenuation on their way to second transducer 108
than similar pulses traveling an equivalent travel distance
TD.sub.1 via cortical and trabecular bone only. Alternatively, if
the ultrasonic pulses bypass cavities 60 via travel path TP.sub.2,
they will still suffer higher attenuation because their travel
distance will be longer thin TD.sub.1. In both scenarios, computer
112 will detect the internal structure (cavities 60), based on the
change in ratio R. When computer 112 detects such a change in ratio
R, it will notify the user (e.g. by issuing an indication on
display 114) that an internal structure lies on the path between
first transducer 106 and second transducer 108.
[0148] It is yet another particular feature of apparatus 100 that
it can measure the depth of an internal structure within hard
tissue, such as the depth of the sinal and.backslash.or nasal
cavities in a maxilla, based on changes in ratio R. According to
this method, the transducers scan the maxilla as explained
heretofore. As soon as computer 112 detects a characteristic change
in ratio R, it means that the penetrating ultrasonic pulses have
first met cavities 60 on their path from first transducer 106 to
second transducer 108. Since the computer receives from location
monitoring device 116 the location of the transducers at any given
moment, the computer can therefore calculate vertical depth L.sub.y
of cavities 60 as the vertical distance from alveolar ridge 64 of
maxilla 50 to the location of the transducers which first
introduced a characteristic change in ratio R. The measured depth
will then be displayed on display 114.
[0149] It is still another particular feature of apparatus 100 that
it can combine some or all of the above methods to produce an
integrated internal image of hard tissue. For example, computer 112
in apparatus 100 can produce and display on display 114 a sectional
image of mandible 30 based on such parameters as vertical depth
L.sub.y, horizontal depth L.sub.x, vertical diameter D.sub.x and
horizontal diameter D.sub.y, of mandibular canal 38 (all obtained
using the teachings of the present invention), combined with such
additional parameters as vertical width S.sub.y and horizontal
width S.sub.x of mandible 30 (obtained using conventional measuring
means). Subsequently, computer 112 can further integrate several
such sectional images of mandible 30 to create and display a
three-dimensional internal image of the mandible.
[0150] Referring now to FIG. 11, an alternative embodiment of the
present invention, designated 200, will be described. Apparatus 200
is an apparatus for non-invasive ultrasonic imaging of hard tissue.
Apparatus 200 is partially similar to apparatus 100, and therefore
common elements will be hereunder denoted with the same reference
numerals. Apparatus 200 comprises a controller 102 coupled to a
pulser.backslash.receiver 104 and to a location monitoring device
116. Pulser.backslash.receiver 104 is coupled to a transducer 120
capable of emitting and receiving ultrasound, and to an
analog-to-digital converter (ADC) 110. ADC 110 is coupled to a
computer 112, which is coupled to a display device 114. Location
monitoring device 116 is coupled to transducer 120 and to computer
112.
[0151] Referring now to FIG. 12 the method of operation of
apparatus 200 will be described. Apparatus 200 operates according
to a pulse-echo method, as opposed to apparatus 100 which is based
on a through-transmission method. A user couples transducer 120 to
an initial location on a surface of an organ being examined, for
example, on first surface 32 of mandible 30. In FIG. 12, first
surface 32 is, for example, a toothless buccal gum surface. As
explained hereinabove in reference to transducers 106 and 108 of
apparatus 100, the same procedure can be performed on other
suitable surfaces inside or outside the mouth cavity. In order to
improve penetration of ultrasound signals into the jaw, the user
applies coupling material 74 between transducer 120 and surface
32.
[0152] When transducer 120 is properly coupled, the user starts the
operation of apparatus 200 using controller 102. The controller
commands location monitoring device 116 to determine the initial
location of transducer 120. Device 116 determines the initial
location using a conventional measuring method and sends the result
to computer 112. The controller further commands
pulser.backslash.receiver 104 to generate electrical pulses and to
send them to transducer 120. Transducer 120 converts the electrical
pulses to ultrasonic pulses and emits them toward first surface 32.
The emitted ultrasonic pulses partially penetrate first surface 32
via coupling material 74. Some of the penetrating ultrasonic pulses
then travel inside mandible 30 through cortical bone layer 34 and
trabecular bone 36. Most of the penetrating pulses travel inside
mandible 30 in an approximately straight trajectory (depicted in
the drawings as a broken-line arrow). The penetrating ultrasonic
pulses are then partially reflected back toward transducer 120 from
the opposite cortical bone layer 34'. In some cases, the
penetrating pulses may also travel through mandibular canal 38 on
their way to opposite surface 34' and after being reflected back
toward transducer 120. Transducer 120 receives ultrasonic echoes
reflected from within mandible 30, converts them into analog
electrical pulses and sends the electrical pulses to ADC 110 via
pulser.backslash.receiver 104. The ADC samples the electrical
pulses which represent the received ultrasonic echo pulses and
sends these samples to computer 112. The computer records, as a
first set of results, the samples which represent the received
pulses along with the initial location of the transducer.
[0153] The user scans mandible 30, for example, by moving
transducer 120 vertically and.backslash.or horizontally along the
surface of mandible 30. FIGS. 13a-3c illustrate an example of a
vertical scanning movement. FIG. 133a shows the initial location of
transducer 120 which is relatively far from mandibular canal 38.
FIG. 13b shows the location of the transducer after having been
moved approximately halfway closer to mandibular canal 38. FIG. 13c
shows the location of the transducer after having been moved
further down, so that mandibular canal 38 lies on the ultrasonic
travel path (depicted as a broken-line arrow) extending
straightforward from the transducer. FIGS. 14a-14b illustrate an
example of a horizontal scanning movement of transducer 120 along
alveolar ridge 40. FIG. 14a shows the initial location of
transducer 120. The transducer is initially placed so that the
travel path (depicted as a broken-line arrow) of ultrasonic pulses
and echoes does not pass through mandibular canal 38. FIG. 14b
shows the transducer after having been moved toward the middle of
the jaw, so that mandibular canal 38 lies on the ultrasonic travel
path extending straightforward from the transducer.
[0154] Alternatively, the user may scan mandible 30 by moving the
transducer in a sweeping motion, or by any other desired scanning
pattern. Apparatus 200 can further be equipped with automatic
mechanical scanning means, for example, a slidable mount to which
transducer 120 is attached and which is programmed to execute a
desired scanning pattern. Alternatively, apparatus 200 can be
equipped with electronic scanning means, for example, an array of
transducers instead of single transducer 120.
[0155] During the scanning process, ADC 110 samples the ultrasonic
pulses received at each new location of the transducers, and
computer 112 keeps recording sets of samples along with the
corresponding location of the transducer. Computer 112 is
programmed to determine certain physical characteristics of the
hard tissue being examined, based on an analysis of the recorded
sets. As mentioned hereinabove in reference to apparatus 100, the
present invention teaches that when, during the scanning process,
mandibular canal 38 is situated on the path extending
straightforward from transducer 120, consequently computer 112 will
detect a local change (increase or decrease) in amplitude of the
penetrating pulses.
[0156] Hence, it is a particular feature of apparatus 200 that it
detects and locates an internal structure within hard tissue (e.g.
the mandibular canal in a mandible), by detecting a local change in
the amplitude of ultrasonic echo pulses. When computer 112 detects
such a local change in the amplitudes it will notify the user (e.g.
by issuing an indication on display 114) that the internal
structure lies on the path extending straightforward from
transducer 120.
[0157] It is another particular feature of apparatus 200 that it
can measure the depth of an internal structure within hard tissue,
for example, the depth of the mandibular canal in a mandible, based
on amplitude measurements. Transducer 120 scans mandible 30
according to the method described above. As soon as computer 112
first detects a characteristic change in the amplitude of received
ultrasonic echo pulses, it means that the pulses have first met
mandibular canal 38 on their path from first transducer 120 to the
surface of reflection. Since the computer receives from location
monitoring device 116 the location of the transducer at any given
moment, the computer can therefore calculate the depth of
mandibular canal as follows. In case of vertical scanning (FIGS.
13a-13c), vertical depth L.sub.y will be calculated as the vertical
distance from alveolar ridge 40 to the location of the transducer
which first introduced a characteristic change in amplitude.
Similarly, in case of horizontal scanning (FIGS. 14a-14b),
horizontal depth L.sub.x will be calculated as the horizontal
distance from surface 32 to the location of the first
characteristic amplitude change.
[0158] It is yet another particular feature of apparatus 200 that
it can measure the diameter of an internal structure of interest
within hard tissue, for example, the diameter of mandibular canal
38 within mandible 30, based on amplitude measurements. Transducer
120 scans mandible 30 according to the method described
hereinabove. When measuring horizontal diameter D, horizontal
scanning (FIG. 14) will be performed, and when measuring vertical
diameter D, vertical scanning (FIG. 13) will be performed. As soon
as computer 112 first detects a characteristic change in the
amplitude of received ultrasonic echo pulses, it means that the
pulses have first met mandibular canal 38 on their path from
transducer 120 to the surface of reflection. Subsequently, when
amplitude returns to its level prior to the characteristic change,
it means that the ultrasonic pulses no longer pass through
mandibular canal 38. Computer 112 then calculates and displays the
diameter of mandibular canal 38 based on the detected borders of
the canal and on location information supplied by location
monitoring device 116.
[0159] It is yet another particular feature of apparatus 200 that
it can detect and locate an internal structure within hard tissue,
for example mandibular canal 38 within mandible 30, based on
spectral function analysis. Transducer 120 scans mandible 30, and
ADC 110 sends to computer 112 samples of the received ultrasonic
echo pulses, all as explained hereinabove. Computer 112 processes
the samples and produces (e.g. using a known FFT algorithm), for
each given location of the transducer, a spectral function
representing ultrasonic pulses emitted and received at that
location. The computer records, for each given location of the
transducer, a set containing the spectral function of the received
ultrasonic pulses along with the corresponding location of the
transducer. Computer 112 can then analyze various characteristics
of the spectral functions of the received ultrasonic pulses to
determine the location of an internal structure within the hard
tissue being examined. As mentioned heretofore in reference to
apparatus 100, a frequency shift in the frequency spectrum of the
received ultrasonic pulses may indicate the presence of mandibular
canal 38 within mandible 30. Hence, when computer 112 detects a
characteristic frequency shift in the spectral function of received
ultrasonic echo pulses, it will notify the user (e.g. by issuing an
indication on display 114) that an internal structure lies on the
ultrasonic travel path extending straightforward from transducer
120. After apparatus 200 detects and locates the internal structure
of interest, the apparatus may further be used in order to measure
the depth of such internal structure using location information
supplied by location monitoring device 116, as explained
heretofore.
[0160] It is yet another particular feature of apparatus 200 that
it can detect and locate an internal structure within hard tissue,
based on artificially amplified characteristics of the received
pulses, such characteristics being indicative of the internal
structure. After computer 112 obtains spectral functions of
ultrasonic pulses received in various locations along mandible 30
(as explained hereinabove), the computer processes the recorded
spectral functions to determine a discrete representative value for
each spectral function. As a result, the computer obtains and
records a first array of representative values as a function of the
locations of the transducer across mandible 30. Following, the
computer analyzes the first array, in order to detect a distinct
local variability in the representative values. In case such
distinct local variability is found, the computer can conclude and
notify the user (e.g. on display 114) that the internal structure
of interest is situated in the locations corresponding to the
locally varying representative values. If no such distinct local
variability is detected, the computer will proceed and obtain a
second array of representative values, which is based on a
different representation criterion than that of the first array. If
the first array is, for example, an array of the total sum of
amplitudes, then the second array can be, for example, an array of
the RMS of amplitudes. The computer analyzes the second array to
find a distinct local variability which indicates the presence of
the internal structure of interest. If again no such distinct local
variability is detected, the computer will perform a predetermined
mathematical manipulation on the first and.backslash.or second
arrays. For example, the computer can divide the first array by the
second array to obtain a third, synthetic array of representative
values as a function of locations across the mandible. The computer
analyzes the third, synthetic array to find a distinct local
variability which indicates the presence of the internal structure.
The computer may repeat the above procedure a desired number of
repetitions.
[0161] It is yet another particular feature of apparatus 200 that
it enables calculating the diameter of an internal structure within
hard tissue, based on analysis of the ratio between the amplitude
of received ultrasonic pulses and the attenuation coefficients
inside the organ being examined. According to this method, after
computer 112 obtains spectral functions of ultrasonic pulses
received in various locations along mandible 30 (as explained
hereinabove), the computer determines the minimal amplitude A.sub.3
of ultrasonic pulses received by transducer 120 during the scanning
process, and the maximal amplitude A.sub.4 of such pulses. As
mentioned hereinabove, the present invention teaches that
attenuation in mandibular canal 38 is typically different than in
cortical 34 and trabecular bone 36. Where attenuation in the
mandibular canal is lower than in cortical and trabecular bone,
minimal amplitude A.sub.3 will be measured when penetrating
ultrasonic pulses do not travel through mandibular canal 38 (FIGS.
13a, 13b or 14a), whereas maximal amplitude A.sub.4 will be
measured when the pulses travel partly via mandibular canal 38
(FIG. 13c or 14b). The attenuation coefficient inside trabecular
bone 36, designated .gamma..sub.1, as well as the attenuation
coefficient inside mandibular canal 38 (approximately equal to the
attenuation coefficient in water) designated .gamma..sub.2, are
both measured using conventional means and are fed into computer
112.
[0162] As mentioned above, it is known in the art that the ratio
between the amplitude A of an ultrasonic signal and the distance S
traveled by the ultrasonic signal inside a medium with an
attenuation coefficient .gamma. can be expressed by the following
first equation:
A.apprxeq.e.sup.-(.gamma..multidot.S)
[0163] Hence, the ratio between minimal amplitude A.sub.3 and
trabecular width S.sub.x can be expressed by the sixth
equation:
A.apprxeq.e.sup.-(.gamma..sup..sub.1.sup..multidot.2.multidot.S.sup..sub.x-
.sup.)
[0164] The ratio between maximal amplitude A.sub.4 and diameter
D.sub.x of mandibular canal 38 can be expressed by the following
seventh equation:
A.sub.4.apprxeq.e.sup.-(.gamma..sup..sub.1.sup..multidot.2.multidot.(S.sup-
..sub.x.sup.-D.sup..sub.x.sup.)+(.gamma..sup..sub.2.sup..multidot.2.multid-
ot.D.sup..sub.x.sup.))
[0165] If the seventh equation is divided by the sixth equation,
then the following eighth equation is obtained: 3 A 4 A 3 = 2 D x (
1 - 2 )
[0166] The above eighth equation can be solved for D, as expressed
by the following ninth equation: 4 D x = ( log A 4 A 3 ) 2 ( 1 - 2
)
[0167] Thus, having acquired minimal and maximal amplitude
measurements A.sub.3 and A.sub.4, and attenuation coefficients
.gamma..sub.1 and .gamma..sub.2 computer 112 calculates and
displays on display 114 horizontal diameter D.sub.x of mandibular
canal 38, using the above ninth equation. Vertical diameter D, can
be measured in a similar manner, based on minimal and maximal
amplitudes A.sub.3 and A.sub.4 measured vertically.
[0168] It is still another particular feature of apparatus 200 that
it can combine some or all of the above methods to produce an
integrated internal image of hard tissue. For example, computer 112
in apparatus 200 can produce and display on display 114 a sectional
image of mandible 30, based on such parameters as vertical depth
L.sub.y, horizontal depth L.sub.x, vertical diameter D.sub.y and
horizontal diameter D.sub.x of mandibular canal 38 (all obtained
using the teachings of the present invention), combined with such
additional parameters as vertical width S.sub.y and horizontal
width S.sub.x of mandible 30 (obtained using conventional measuring
means). Subsequently, computer 112 can further integrate several
such sectional images of mandible 30 to create and display a
three-dimensional internal image of the mandible.
[0169] Referring now to FIG. 16, yet another alternative embodiment
of the present invention, designated 300, will be described.
Apparatus 300 is an apparatus for non-invasive ultrasonic imaging
of hard tissue. Apparatus 300 is partially similar to apparatuses
100 and 200, and therefore common elements will be hereunder
denoted with the same reference numerals. Apparatus 300 comprises a
controller 102 coupled to a pulser.backslash.receiver 104 and to a
location monitoring device 116. Pulse.backslash.receiver 104 is
coupled to a multiplexer (MUX) 130, which is coupled to a first
transducer 106 and to a second transducer 108. Transducers 106 and
108 are capable of emitting and receiving ultrasound.
Pulser.backslash.receiver 104 is further coupled to an
analog-to-digital converter (ADC) 110, coupled to a computer 112,
which is coupled to a display device 114. Location monitoring
device 116 is coupled to first transducer 106, to second transducer
108, and to computer 112.
[0170] Apparatus 300 is capable of operating in several modes of
operation. In a first mode of operation, the through-transmission
mode, a user sets MUX 130 so that it directs an output electrical
signal from pulser.backslash.receiver 104 to first transducer 106,
and further directs the analog electrical signal which represents
the ultrasonic signal received by second transducer 108 back to the
pulser.backslash.receiver 104. In this mode apparatus 300 actually
operates like apparatus 100, as explained hereinabove. In a second
mode of operation, the pulse-echo mode, the user sets MUX 130 so
that it directs an output electrical signal from
pulser.backslash.receiver 104 to first transducer 106, and further
directs the analog electrical signal which represents the
ultrasonic signal received by first transducer 106 back to the
pulser.backslash.receiver. In this mode apparatus 300 actually
operates like apparatus 200, as explained hereinabove. In a third
mode of operation, a combined mode, apparatus 300 operates in the
first mode to obtain a first set of measurements; and then
apparatus 300 operates in the second mode to obtain a second set of
measurements; computer 112 records the first and second sets of
measurements, and integrates them to produce and display on display
114 an integrated internal image of the hard tissue being examined,
for example, a sectional image or a three-dimensional image based
on a plurality of sectional images.
[0171] Referring now to FIG. 17 still another alternative
embodiment of the present invention, designated 400, will be
described. Apparatus 400 is an apparatus for non-invasive
ultrasonic imaging of hard tissue. Apparatus 400 is partially
similar to apparatus 300, and therefore common elements will be
hereunder denoted with the same reference numerals. Apparatus 400
comprises a controller 102 coupled to a pulser.backslash.receiver
104 and to a location monitoring device 116.
Pulser.backslash.receiver 104 is coupled to a multiplexer (MUX) 130
and also to an analog-to-digital converter (ADC) 110. ADC 110 is
coupled to a computer 112 coupled to a display device 114. MUX 130
is further coupled to an array of transducers 140 containing a
plurality of transducers, for example, eight transducers 141-148.
Each transducer in array 140 is capable of emitting and receiving
ultrasound. Apparatus 400 further comprises a location monitoring
device 116 coupled to each of the transducers in array 140 and
further-coupled to computer 112.
[0172] Referring now to FIG. 18, the method of operation of
apparatus 400 will be described. A user couples transducers 141-148
to an organ being examined so that at least some of the transducers
are facing each other. For example, transducers 141-148 may be
placed around a gum surface 32 of a mandible 30 as illustrated in
FIG. 18. The user applies a coupling material 74 between each
transducer and the surface to which it is coupled, as explained
hereinabove in reference to apparatus 100. When the transducers are
properly coupled, the user starts the operation of apparatus 400
using controller 102. The controller commands location monitoring
device 116 to determine the position of each of the transducers in
array 140 with respect to the other transducers therein and with
respect to surface 32 to which they are coupled. Device 116 sends
the locations to computer 112 which records them.
[0173] Next, apparatus 400 electronically scans the organ being
examined, as follows. Controller 102 commands
pulser.backslash.receiver 104 to generate electrical pulses and
send them to MUX 130 and to ADC 110. The ADC samples the electrical
pulses, and sends to computer 112 the samples which represent the
emitted pulses. MUX 130 directs the electrical pulses from
pulser.backslash.receiver 104 to a first transducer 141. The
ultrasonic pulses emitted from first transducer 141 partially
penetrate mandible 30 and then travel inside the mandible
eventually reaching one or more of the remaining transducers in
array 140. The receiving transducers convert the received
ultrasonic pulses to analog electrical pulses, and send the latter
to MUX 130. The MUX directs analog electrical pulses from the
remaining transducers back to ADC 110 via pulser.backslash.receiver
104. The ADC samples the electrical pulses and sends the samples,
which represent the received ultrasonic pulses, to computer 112.
The computer records the digital samples in discrete sets, wherein
each set contains samples representing ultrasonic pulses emitted by
one certain transducer and received by another certain transducer,
along with the locations of these transducers (as determined by
device 116). The above procedure is repeated several times, whilst
each time a different transducer from array 140 emits ultrasound
and the remaining transducers receive ultrasound. FIG. 18
illustrates an example of various possible ultrasonic travel paths
(depicted as broken lines) inside mandible 30.
[0174] At the end of the scanning process described heretofore,
computer 112 will have accumulated a desired number of sets of
samples and travel paths. The computer processes the accumulated
sets, and converts each set of samples and ultrasonic travel path
into a set of a predetermined integral physical quantity and travel
path. For example, the computer can calculate, based on samples of
the emitted and received ultrasonic pulses in each travel path, the
integral attenuation in each travel path. Following, the computer
implements a known method, such as a Radon Transform algorithm, in
order to deduce from the sets of integral physical quantity and
travel path, a physical quantity per each point inside the hard
tissue. For example, the computer can use a Radon Transform
algorithm for deducing from all the sets of integral attenuation
per travel path, the level of attenuation in each discrete point
inside the scanned cross-section of the mandible. The computer can
then display on display 114 a sectional internal image of mandible
30, based on the deduction algorithm.
[0175] It is a particular feature of apparatus 400 that it can
detect, locate and measure the size of an internal structure within
hard tissue, for example, a mandibular canal 38 in a mandible 30.
As mentioned above, the level of ultrasonic attenuation inside
mandibular canal 38 is typically different than in cortical 34 and
trabecular bone 36. The level of attenuation at each point inside
mandible 30 can be determined using apparatus 400 as explained
hereinabove. Following, computer 112 of apparatus 400 can detect
mandibular canal 38 by finding the locations within mandible 30
that are characterized with an attenuation level other than that of
its surroundings. Horizontal depth L.sub.x, vertical depth L.sub.y,
horizontal diameter D.sub.x, and vertical diameter D.sub.y (see
FIG. 12) of mandibular canal 38, as well as other parameters
pertaining to the size and location of the internal structure of
interest, can all be calculated based on location information
obtained by device 116 and on the Radon Transform internal image of
mandible 30.
[0176] It is another particular feature of apparatus 400 that it
can further integrate several sectional images of the hard tissue
being examined, to create and display a three-dimensional internal
image of the hard tissue.
[0177] Thus, it is evident that the present invention provides a
real-time, chair-side, accurate, safe, radiation-free, and
economical method and apparatus for non-invasive ultrasonic imaging
of hard tissue.
[0178] While preferred embodiments of the present invention have
been disclosed hereinabove, it is to be understood that these
preferred embodiments are given as an example only and are not
intended to be limiting. Those skilled in the art may make various
modifications and additions to the embodiments used to illustrate
the teachings of the present invention and those modifications and
additions would remain within the scope of the present
invention.
[0179] It is emphasized that the present invention is not limited
to imaging human jaws. Other uses, including but not limited to
imaging other types of human hard tissue, in addition to animal
hard tissue, are included in the scope of the present
invention.
[0180] Although the invention has been described in conjunction
with specific embodiments thereof, it is evident that many
alternatives, modifications and variations will be apparent to
those skilled in the art. Accordingly, it is intended to embrace
all such alternatives, modifications and variations that fall
within the spirit and broad scope of the appended claims. All
publications, patents, patent applications mentioned in this
specification are herein incorporated in their entirety by
reference into the specification, to the same extent as if each
individual publication, patent, patent application was specifically
and individually indicated to be incorporated herein by reference.
In addition, citation or identification of any reference in this
application shall not be construed as an admission that such
reference is available as prior art to the present invention.
* * * * *